院前心电图特征在院外无脉性电活动骤停中的预后标志物的作用。
Utility of prehospital electrocardiogram characteristics as prognostic markers in out-of-hospital pulseless electrical activity arrests.
机构信息
Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
出版信息
Emerg Med J. 2018 Feb;35(2):89-95. doi: 10.1136/emermed-2017-206878. Epub 2017 Oct 21.
BACKGROUND
It is unclear if there are predictors of survival, including ECG characteristics, that can guide resuscitative efforts in pulseless electrical activity (PEA) cardiac arrests. We studied the predictive potential of presenting prehospital ECGs on survival for patients with out-of-hospital cardiac arrest (OHCA) with PEA.
METHODS
We studied prehospital ECGs of patients with OHCA prospectively enrolled between June 2007 and November 2009 at the Ottawa/OPALS (Ontario Prehospital Advanced Life Support Study) site of the Resuscitation Outcomes Consortium PRIMED study (Prehospital Resuscitation using an IMpedance valve and Early versus Delayed analysis). We included adult non-traumatic OHCA with PEA rhythm where resuscitation was attempted. We measured HR, QRS interval and presence of P waves, and determined their impact on return of spontaneous circulation (ROSC) and survival to hospital discharge (SHD) using multivariate regression analysis.
RESULTS
The demographic characteristics of the 332 included cases were the following: mean age 71.8, male 58.4%, SHD 5.4% and ROSC at ED arrival 26.5%. Survivors had similar HR (56.8 vs 52.0 beats per minute (bpm), p=0.53) and QRS intervals (128.7 vs 129.6 ms, p=0.95) compared with non-survivors. Prehospital ECG characteristics did not predict SHD or ROSC on multivariate analyses. Patients with initial HR <30 bpm had a 3.8% survival rate; those with both HR <30 bpm and QRS≥120 ms had a 3.7% survival rate. Location of arrest predicted SHD (adjusted OR (AdjOR)=1.49, 1.11 to 1.99; p=0.007). Atropine use negatively predicted SHD (AdjOR=0.06, 0.02 to 0.22; p<0.001). Predictors of ROSC ALS paramedic on scene (AdjOR=8.90, 1.11 to 71.41; p=0.04) and successful intubation (AdjOR=3.35, 1.75 to 6.39; p<0.001). Atropine use negatively predicted ROSC (AdjOR=0.27, 0.14 to 0.50; p<0.001).
CONCLUSIONS
Presenting prehospital ECG characteristics did not predict SHD or ROSC in OHCA PEA victims and should not be used to guide termination of resuscitation. Location of arrest was a positive predictor for SHD; atropine use was a negative predictor. ALS paramedic on scene and successful intubation were positive predictors of ROSC; atropine use was a negative predictor.
TRIAL REGISTRATION NUMBER
NCT00394706; post-results.
背景
目前尚不清楚是否存在可预测生存率的指标，包括心电图特征，以指导无脉性电活动（PEA）心脏骤停患者的复苏努力。我们研究了院前心电图在预测 OHCA 伴有 PEA 患者生存率方面的预测潜力。
方法
我们前瞻性地研究了 2007 年 6 月至 2009 年 11 月期间，渥太华/OPALS（安大略省院前高级生命支持研究）复苏结果联盟 PRIMED 研究（院前使用阻抗阀和早期与延迟分析进行复苏）的 OHCA 患者的院前心电图。我们纳入了尝试复苏的成人非创伤性 OHCA 伴 PEA 节律。我们测量 HR、QRS 间隔和 P 波的存在，并使用多变量回归分析确定它们对自主循环恢复（ROSC）和医院出院（SHD）的影响。
结果
332 例纳入病例的人口统计学特征如下：平均年龄 71.8 岁，男性 58.4%，SHD 5.4%，ED 到达时 ROSC 26.5%。与非幸存者相比，幸存者的 HR（56.8 与 52.0 次/分钟（bpm），p=0.53）和 QRS 间隔（128.7 与 129.6 ms，p=0.95）相似。多变量分析显示，院前心电图特征不能预测 SHD 或 ROSC。初始 HR<30 bpm 的患者存活率为 3.8%；同时 HR<30 bpm 和 QRS≥120 ms 的患者存活率为 3.7%。心脏骤停的位置预测 SHD（调整后的 OR（AdjOR）=1.49，1.11 至 1.99；p=0.007）。使用阿托品可降低 SHD 的可能性（AdjOR=0.06，0.02 至 0.22；p<0.001）。ROSC 的预测因素包括 ALS 护理人员在现场（AdjOR=8.90，1.11 至 71.41；p=0.04）和成功插管（AdjOR=3.35，1.75 至 6.39；p<0.001）。使用阿托品可降低 ROSC 的可能性（AdjOR=0.27，0.14 至 0.50；p<0.001）。
结论
OHCA PEA 患者的院前心电图特征不能预测 SHD 或 ROSC，不应用于指导复苏的终止。心脏骤停的位置是 SHD 的正预测因子；阿托品的使用是一个负预测因子。ALS 护理人员在现场和成功插管是 ROSC 的正预测因子；阿托品的使用是一个负预测因子。
试验注册号
NCT00394706；post-results。
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